Brand Application
Business Detail:
*First Name
*Last Name
*Name of Business
*Type of Operation
*Years in Operation
*# of Units/Locations will be participating
Contact Detail:
*Address Line 1
Address Line 2
*Zip Code
*Contact Phone#
Who is your main food distributor
Does your business have any of the following:
Does your business facility serve any of these:
Buffalo Chicken Wings
Chicken Tenders

I hereby authorize Cluck-U, Corp. and its agent(s) to thoroughly investigate my background, employment record, criminal record, credit history, and other matters related to my qualifications for a Cluck-U Chicken Brand unit. I authorize any person, including my current employer (if applicable), previous employers, credit reporting agencies, or other reporting persons or organizations contacted by Cluck-U, Corp. to provide any relevant information regarding this application or my history.

I waive my rights under the Privacy Act, 5 U.S.C. 552a and similar state laws.
By submitting responses to this questionnaire, I agree that Cluck-U, Corp. many rely on my responses.

I understand that misrepresentation or omission of facts may result in rejection of my application. By typing my name and submitting this questionnaire, I agree to all the preceding terms.


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